Interventions in maternal and infant nutrition in the first 1000 days with a focus on socio-economic status: evidence review

Mahesh Sarki, Tim Lobstein

Publikation: Bog/antologi/rapport/kliniske retningslinjerRapportForskningpeer review


The concept of ‘the first 1000 days’ embraces the period from around conception through gestation, birth and infancy to age two years. In this review we identify interventions which show an impact on the socio-economic gradient in nutrition and obesity for mothers (and fathers) and infants in this period.
Conceptual model
A ‘life course’ approach to health promotion considers the influence on children of the nutritional status of their parents, and how the nutritional status of children as they grow to adulthood will have an influence on their children in turn. Policies which improve the pre-conceptual nutrition of parents-to-be will have follow-on benefits for the child, and for their children in turn. Such policies can help EU Member States to decrease the risk of childhood obesity, improve maternal health, and reduce health disparities in the most disadvantaged groups. This life-course approach is shown in Figure 1.
Figure 1: Life-course framework for understanding inequalities in childhood obesity

BMI = body mass index.
Source: Pérez-Escamilla1
At each stage in the cycle, there are potential socio-economic disparities with resulting effects on the social gradient in nutritional status. Women who become pregnant when they are overweight are more likely to gain excessive weight during pregnancy and to retain more weight after delivery. Women within low SES groups tend to have more children and thus they are exposed more to the impact of repeated pregnancies. Women who are obese and/or gain excessive weight during pregnancy are more likely to deliver new-borns who are predisposed to getting 5

childhood obesity, especially if infant feeding practices are not optimal and such sub-optimal feeding is more likely in lower SES groups. This will set an infant on a trajectory, especially if it is a girl, to be obese before they become pregnant and so repeat the cycle, transferring the risk of obesity to the next generation.
This life-course framework is supported by two systematic reviews that examined the evidence published between 1 January 1980 and 12 December 20142. In these reviews, several risk factors were consistently associated with childhood overweight: higher maternal pre-pregnancy body mass index (BMI); excess maternal weight gain during pregnancy; prenatal tobacco exposure; high infant birth weight; and high infant weight gain.
The two reviews include interventions starting in pregnancy and continuing after birth and those starting after birth but before age 2 years. The first review3 included: prevention of childhood overweight or obesity as an outcome, identifies gaps in current research, and discusses conceptual frameworks and opportunities for future interventions. The review was based on 34 articles representing 26 completed interventions, as well as 46 ongoing trials. Nine of the interventions were effective for general population groups but not necessarily for low socio-economic groups. The majority of interventions targeted individual-level behaviour and many were confined to clinical settings; few examined the early-life systems, infrastructures, and policies that impact childhood obesity.
The second review4 presents the evidence on interventions that could prevent childhood obesity later in life and described modifiable childhood obesity risk factors that are present from conception to age 2. Several risk factors were consistently associated with later childhood obesity, including: higher maternal pre-pregnancy BMI; excess maternal gestational weight gain; prenatal tobacco exposure; high infant birth weight; and accelerated infant weight gain. The authors conclude that reducing maternal pre-conceptual overweight, gestational weight gain, and healthy infant weight gain by implementing nutrition recommendations shows promise for childhood obesity prevention.
Policy interventions on marketing of breast-milk substitutes appear to influence socio-economic differences in breast feeding. On average, mothers with high levels of education appear to breastfeed significantly more compared with those with low levels – with those with lower levels of education relying more on professional advice than more highly educated women who rely on written material.5 When breast-milk substitutes are provided for free in maternity facilities and when they are promoted by health workers and in the media, there is evidence that this undermines breastfeeding.6 Conversely, when breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased.7 Given the correct policy infrastructure, breastfeeding rates can improve dramatically in a very short time. 6

This report summarises the evidence base for interventions and policies that affect certain aspects of diet and obesity and which show differential effects on different socio-economic groups, focussing on maternal and infant nutrition with regard to the EU Member States.

ForlagEuropean Commission
StatusUdgivet - 2017
BegivenhedInterventions in maternal and infant nutrition in the first 1000 days with a focus on socio-economic status -
Varighed: 1 jan. 2017 → …


KonferenceInterventions in maternal and infant nutrition in the first 1000 days with a focus on socio-economic status
Periode01/01/17 → …


  • Sundhed, ernæring og livskvalitet